Tattoos have been popular throughout history. Otzi the Iceman (c. 3300 BCE) had 57 separate tattoos. See Callaway, World's Oldest Tattoos Were Made of Soot, New Sci. (Jul. 15, 2009). A tattooed mummy (c. 300 BCE) was extracted from the permafrost of Altaï in the second half of the 15th century. Badenkov, Altai Mountain Knot: Between Conservation and Development, in Connectivity Conservation Management: A Global Guide 246 (Worboys, et al. eds. 2010).
Since the 1990s, tattoos have become a mainstream part of global and Western fashion, common among both sexes, to all economic classes, and to age groups from the later teen years to middle age. Tattoos have been particularly popular in America. In 2008, 14 percent of all adults in the United States had a tattoo, slightly down from 2003, when 16 percent had a tattoo. Among age groups, 9 percent of those ages 18-24, 32 percent of those 25-29, 25 percent of those 30-39 and 12 percent of those 40-49 have tattoos, as do 8 percent of those 50-64. Men were slightly more likely to have a tattoo than women (15 percent versus 13 percent). See Harris Interactive, Three in Ten Americans with a Tattoo Say Having One Makes Them Feel Sexier or More Artsy (Feb. 12, 2008). And the trend is not limited to America. In 2010, 25 percent of Australians under age 30 had tattoos. See Stack, I'm Inked Therefore I Am: Why Tatts Have Left a Mark on Gen Y, Sun. Tele. (Oct. 31, 2010). And in 2011, even Barbie—sold throughout the industrialized world—donned tattoos. See Krupnick, Tokidoki Barbie Features Tattoos, Pink Hair, The Huffington Post (Oct. 19, 2011).
The traditional method of tattooing involves placing pigment into the skin's dermis, the tissue layer below the epidermis. The body then detects the presence of the foreign pigment material, and the immune system discharges phagocytes to engulf the pigment particles. The engulfed particles then remain lodged in the layer just below the boundary between the dermis and the epidermis. See Suthamjariya, Lasers in Dermatology 40-17, in Biomedical Photonics Handbook (Vo-Dinh ed. 2003).
There are at least two shortcomings with the traditional method of tattooing—regret, and safety. Although the majority of people who get tattoos do not regret doing getting tattoos, about 16 percent want to remove them (see Harris Interactive, supra), and removal is both painful and expensive. The principal reasons given by patients for tattoo removal are moving on from the past, problems wearing clothes, embarrassment, and concerns that tattoos could adversely affect job or career. See Armstrong, et al., Motivation for Contemporary Tattoo Removal, 144 Arch. Dermatol. 879-84 (2008).
The markets for both getting and removing tattoos tend to be seasonal. The preference for getting tattoos is highest in the summer, when people tend to wear less clothing, get more tanned, are more conscious of their bodies and what they communicate to others, and want to feel sexier. See Divito, Summer is Tattoo Season, The Associated Press (Jun. 17, 2007) (“It's summer, and that means it's tattoo season, the best time of the year to show off—or take in—all that sexy ink”); Harris Interactive, supra. The preference for removing tattoos, however, is highest in the winter, when people tend to wear more clothing, work more, be less conscious of their bodies and what they communicate to others, care less about feeling sexier, and be more concerned about how tattoos might adversely affect job or career. See Saint Louis, A Change in Season and Regimen, NYT (Nov. 10, 2010); Armstrong, supra.
There other shortcoming concerns the many health risks associated with tattoos. Allergic and lichenoid reactions, for example, can occur from any of the classic pigments and their degradation products. See Kaatz, Body-Modifying Concepts and Dermatologic Problems: Tattooing and Piercing, 26 Clinics Dermatol. 35-44 (2008). Delayed contact urticaria has also been reported. See Bagnato, et al., Urticaria in a Tattooed Patient, 27 Allergol. Immunopathol. 32-33 (1999). On occasion, morphealike lesions (see Mahalingam, et al., Morphea-Like Tattoo Reaction, 24 Am. J. Dermatopathol. 392-95 [2002]) and marked pseudoepitheliomatous hyperplastic lesions (Balfour, et al., Massive Pseudoepitheliomatous Hyperplasia: An Unusual Reaction to a Tattoo, 25 Am. J. Dermatopathol. 338-40 [2003]) have been reported.
Another risk is infection—both bacterial and viral. Severe systemic bacterial infections after tattooing include sepsis, endocarditis, and spinal and epidural abscesses, by Streptococcus pyogenes, Staphylococcus aureus, or Pseudomonas. See Satchithananda, et al., Bacterial endocarditis following repeated tattooing, 85 Heart 11-12 (2000). Infection with Treponema pallidum and typical or atypical mycobacteria has also been reported. See Long & Rickmann, Infectious Complications of Tattoo, 18 Clin. Infect. Dis. 610-19 (1994). Viral infections include hepatitis B and C, HIV, papilloma, and mollusca contagiosa. See Perez, et al., Molluscum Contagiosum on a Multicoloured Tattoo, 20 J. Eur. Acad. Dermatol. Venereol. 214-38 (2006); Nishioka & Gyorkos, Tattoos As Risk Factors for Transfusions Transmitted Diseases, 5 Int'l J. Infect. Dis. 27-34 (2001); Haley & Fischer, Commercial Tattooing as a Potentially Important Source of Hepatitis C Infection, 80 Medicine 134-51 (2000); Doll, Tattooing in prison and HIV infection, 1 Lancet 66-67 (1988).
One of the most dangerous health risks from tattooing is malignant tumors, including malignant melanoma (see Kircik, et al., Malignant Melanoma in a Tattoo, 32 Int'l J. Dermatol. 297-98 [1993]), basal cell carcinoma (see Doumat, et al., Basal Cell Carcinoma in a Tattoo, 208 Dermatol. 181-82 [2004]), squamous cell carcinoma (see McQuarrie, Squamous-Cell Carcinoma Arising in a Tattoo, 49 Minn. Med. 799-801 [1966]), and primary non-Hodgkin lymphoma (see Armiger & Caldwell, Primary Lesion of a Non-Hodgkin's Lymphoma Occurring in a Skin Tattoo: Case Report, 62 Plast. Reconstr. Surg. 125-27 [1978]).
An alternative to traditional tattooing, cryogenic hypopigmentation, involves applying a protective design template to the skin and then using a cryogenic agent (such as liquid nitrogen) to freeze the exposed portions of the skin, thereby destroying the dermal melanocytes and hypopigmenting the exposed tissue. See Method for Producing a Permanent or Nearly Permanent Skin Image, Design or Tattoo by Freezing the Skin, U.S. Patent Publication No. 20110257642 (published Oct. 20, 2011) (Charles Sherman Griggs, III, applicant). From a health perspective, the abandonment of pigments could overcome many of the serious health risks associated with traditional tattooing. The use of cryogen agents, however, poses a whole new set of health risks including thermal burns, frostbite, skin adhesion to frozen metals and skin tears, asphyxiation, toxicity, and explosion due to rapid expansion.
From a regrets perspective, the cryogenic hypopigmentation approach may be more appealing because a hypopigmented design on the skin will tend to be more apparent on tanned skin on the summer—when the preference for getting tattoos is highest—and less apparent on pale skin in the winter—when regrets and the associated preference for removing tattoos is highest. On the other hand, it is difficult to achieve highly detailed designs with cryogenic hypopigmentation. The templates can only accommodate a limited amount of detail, so this approach will be limited to simpler, grosser designs, which will tend to me less unique and less appealing. In addition, it is difficult to restrict the effects of dermal freezing to the exposed tissue, as it tends to bleed under the borders of the template. The borders of the design will therefore be uneven and imprecise, thereby producing a less appealing design. As a result, regrets and removal may run just as with this approach as with the traditional tattooing approach.
There is therefore a need for a method of tattooing that reduces or eliminates the safety risks of tattoo needles, tattoo pigments, and cryogenic agents, as well as the regrets from the winter design visibility of traditional tattoos and the lack of refinement of cryogenic hypopigmentation.